January 2020 Stay Bookings

Student Name

Student Number

(For new students please enter your Application Reference Number found at the top left hand corner of your Offer Letter ie MD001)

Contact Number

Date of Birth

DD/MM/YYYY

Gender

Male
Female

Nationality

Religion

Emergency Contact Details - Guardian*

Name

Contact Number

Academic Programme

Room Type

Do you have one of the following health conditions?

If ‘yes’, please select from the list below that describes your impairment:

Long standing illness or health condition
Mental health condition
Physical or mobility impairment
Sensory impairment

If other, please specify:

Once the student has submitted their request, they will be contacted by the Accommodation Office with details on how to proceed with their reservation.

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